pancreatic insuffencey

[ttcoffin]

Does anyone know what this is and what the symptoms would be? They say my husband has this but I know nothing about it. Thanks.......

[Nanny]

This is a cut and paste which explains what pancreatic insufficency means:

Pancreatic Insufficiency
Also indexed as: Pancreatitis (Acute and Chronic)

Pancreatic insufficiency occurs when the pancreas does not secrete enough chemicals and digestive enzymes for normal digestion to occur. When pancreatic insufficiency is severe, malabsorption (impaired absorption of nutrients by the intestines) may result, leading to deficiencies of essential nutrients and the occurrence of loose stools containing unabsorbed fat (steatorrhea).

Severe pancreatic insufficiency occurs in cystic fibrosis, chronic pancreatitis, and surgeries of the gastrointestinal system in which portions of the stomach or pancreas are removed. Certain gastrointestinal diseases, such as stomach ulcers,1 celiac disease,2 and Crohn’s disease,3 and autoimmune disorders, such as systemic lupus erythematosus (SLE),4 5 6 may contribute to the development of pancreatic insufficiency. Mild forms of pancreatic insufficiency are often difficult to diagnose, and there is controversy among researchers regarding whether milder forms of pancreatic insufficiency need treatment.

Pancreatitis is an inflammation of the pancreas that reduces the function of the pancreas, causing pancreatic insufficiency, malabsorption, and diabetes.7 Acute pancreatitis is usually a temporary condition and can be caused by gallstones, excessive alcohol consumption, high blood triglycerides, abdominal injury, and other diseases, and by certain medications and poisons.8 Chronic pancreatitis is a slow, silent process that gradually destroys the pancreas and is most often caused by excessive alcohol consumption.



Checklist for Pancreatic Insufficiency
Rating Nutritional Supplements Herbs
Digestive enzymes  
Beta-carotene
Methionine
Selenium
Vitamin C
Vitamin E  
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.


What are the symptoms of pancreatic insufficiency? People with pancreatic insufficiency may have symptoms of pale, foul-smelling, bulky stools that stick to the side of the toilet bowl or are difficult to flush, oil droplets floating in the toilet bowl after bowel movements, and abdominal discomfort, gas, and bloating. People with pancreatic insufficiency may also have bone pain, muscle cramps, night blindness, and easy bruising.



Conventional treatment options: The conventional treatment includes taking pancreatic enzymes with meals. In advanced cases, doctors may also recommend intravenous nutritional supplements of the fat-soluble vitamins (e.g., vitamins A, D, E, K).



Dietary changes that may be helpful: A low-fat diet (with no more than 30 to 40% of calories from fat) is often recommended to help prevent the steatorrhea that often accompanies pancreatic insufficiency.9 In a controlled study of chronic pancreatitis patients, a very low-fat diet resulted in less than one-fourth as much steatorrhea compared to a more typical fat intake.10 Since a very low-fat diet may not be appropriate for a person with malnutrition, this recommendation should only be followed after consulting a healthcare professional.

A preliminary study of chronic pancreatitis patients reported that a high-fiber diet was associated with a small but significant increase in the amount of fat in the stool.11 The patients all complained of increased flatulence while using this diet, but an undesirable increase in the frequency of bowel movements did not occur. Increases in dietary fiber may not be well tolerated by people with pancreatitis, but more research is needed.

A few preliminary reports suggest that food allergy may cause some cases of acute pancreatitis. Food allergies identified in these cases included beef, milk, potato, eggs,12 fish and fish eggs,13 and kiwi fruit.14 No research has investigated the possible role of food allergy in other causes of pancreatic insufficiency.



Lifestyle changes that may be helpful: Since alcoholism is one known cause of pancreatitis, total abstinence from alcohol is generally recommended to people with this disease.15 In a study of alcoholic chronic pancreatitis patients, pancreatic function declined to a greater degree in those who continued to drink alcohol.16 Another study found that abstinence from alcohol had a significant long-term beneficial effect on some of the problems associated with chronic pancreatitis.17

Cigarette smoking decreases pancreatic secretion18 and increases the risk of pancreatitis19 and pancreatic cancer,20 providing yet another reason to quit smoking.

In a large international study, the major risk factors for early death in a group of patients with chronic alcoholic and nonalcoholic pancreatitis included smoking and drinking alcohol.21



Nutritional supplements that may be helpful: The mainstay of treatment for pancreatic insufficiency is replacement of digestive enzymes, using supplements prepared from pig pancreas (pancrelipase) or fungi.22 Enzyme supplements have been shown to reduce steatorrhea23 24 associated with pancreatitis, while pain reduction has been demonstrated in some,25 26 though not all,27 28 double-blind studies. Digestive enzyme preparations that are resistant to the acidity of the stomach are effective at lower doses compared with conventional digestive enzyme preparations.29 Some enzyme preparations are produced with higher lipase enzyme content for improved fat absorption, but one controlled study of chronic pancreatitis found no advantage of this preparation over one with standard lipase content.30 People with more severe pancreatic insufficiency or who attempt to eat a higher-fat diet require more enzymes,31 but large amounts of pancreatic digestive enzymes are known to damage the large intestine in some people with diseases causing pancreatic insufficiency.32 33 34 Therefore, a qualified healthcare practitioner should be consulted about the appropriate and safe amount of enzymes to use.

Many, otherwise healthy people suffer from indigestion, and some doctors believe that mild pancreatic insufficiency can be a cause of indigestion. A preliminary study of people with indigestion reported significant improvement in almost all of those given pancreatic enzyme supplements.35 One double-blind trial found that giving pancreatic enzymes to healthy people along with a high-fat meal reduced bloating, gas, and abdominal fullness following the meal.36

Stomach surgery patients often have decreased pancreatic function, malabsorption, and abdominal symptoms, including steatorrhea, but digestive enzyme supplementation had no effect on steatorrhea in two of three double-blind studies of stomach surgery patients,37 38 39 although some other symptoms did improve.40 41 Patients who have surgery to remove part of the pancreas often have severe steatorrhea that is difficult to control with enzyme supplements.42 In one double-blind study, neither high-dose nor standard-dose pancreatin was able to eliminate steatorrhea in over half of the pancreas surgery patients studied.43

Fat malabsorption in pancreatic insufficiency may result in deficiencies of fat-soluble vitamins, and these deficiencies may not always be prevented by enzyme supplementation.44 45 46 One controlled study found that patients with chronic pancreatitis had vision abnormalities that are associated with vitamin A deficiency.47 A controlled study of patients with steatorrhea found that a water-soluble form of vitamin A was easier to absorb than conventional fat-soluble forms of vitamin A, resulting in vitamin A absorption equal to that of healthy people.48 Two controlled studies of patients with chronic pancreatitis found evidence of vitamin E deficiency in their blood.49 50 People with more severe fat malabsorption tended to have the lowest vitamin E levels. Although doctors sometimes recommend supplementation with fat-soluble vitamins for people with pancreatitis,51 no research has investigated the benefits of these supplements.

I hope this helps.
Nanny

[ttcoffin]

Wow nanny, thank you sooo much. I have thought all along that all of his pain and symptoms matched pancreas problems. When the CT scan showed up normal, the doc wasn't even going to consider the pancreas anymore but I asked about a blood test,to check on his enzymes(something I learned here) and so she did and she found out about the low enzymes and put him on enzyme pills today. He hasn't eaten yet, so he hasn't tried them. He said that on the days he can't eat because he is prepping for a test, he feels less pain. Sounds like the pancreas is causing the pain but the nurse said that she wasn't sure if low enzymes would cause pain. uggg, I get so confused because I read things on the internet and it sounds so obvious to what he has but then the docs don't seem to even pick up on it. They are suppose to have the degree and get the big bucks, but for what? Well, anyway, I'm done venting and Iam very glad I found this website, thanks to all who have responded to me!!

[Nanny]

I checked your earlier post because I wasn't sure if your husband's doctor was a gastroenterologist.  For someone who specializes in this field she doesn't seem to be too familar with pancreatic insufficiency, and it's causes.  You mentioned that he had "low" enzymes.  What were his actual amylase and lipase levels?  Did she do a tryglyceride test?

A very LOW FAT diet should help your husband with the pain.  Avoid red meats, fried foods and alcohol.  Most people with pancreatic insufficiency can't tolerate  more than 25-30 grams of fat on a daily basis.  The pancreas inability to digest fat is what causes the pain.

Did she do a fecal fat test to determine whether there was excess fat in the stool?  There are a lot of other tests that can be done to find out what is causing this.  Unfortunately this doesn't always show up on a cy-scan and that's when other tests are necessary.

Good luck.
Nanny

[ttcoffin]

nanny...... Well, here are the numbers:triglecerides are 172 and the ldl(bad cholesterol) is 197. He is now on cholesterol meds.His amylase is 27 and his lipase is 34(I guess that is in the normal range).His tsh level is 13.8, very high, so we know he has underactive thyroid now too. The doc does not seem very familar with the pancreas or I would not have to of mentioned taking blood to check it. We are seeing a new internal medicine doc on TUesday, and maybe he can take over the pancreas and thyroid problem. I like this gastro doc and has done really good on all of his other problems but not much with the pancreas. My husband did say that when he eats red meat, he suffers more. He eats more chicken and fish lately. He hasn't drank any alcohol in almost 4 years, when he found out he had barretts esophagus.we will try the less fat every day and see if this gives him some relief. My question also is, the artice you cut and pasted,mentioned that the leading cause of pancreatic inssufiency was chronic pancreatitis. So, shouldn't they ahve to treat that too? Or will the enzyme pills by themself help now? The doc did a stool test, for fat  and it came back negative but there are sometimes you can see the fatty stools, I think that particular stool didn't have any. He has passed bullet looking things,that are sort of orange. The doc had said it seemed like fat globulars. But he doesn't pass them each time. On the days he eats hardly any fat, there are none in his stools. When he has diahrea, he said he can see like an oily substance in the toilet. Well, thanks again for all of your suggestions and advice. If these numbers mean anything to you, please let me know. Thanks.......

[Nanny]

The triglyceride level is borderline high and his cholesterol is high, so I can see the need for cholesterol medication.  Tell your husband that the low fat diet will also help with his cholesterol problem, in addition to the pancreatic insufficiency.  The amylase and lipase levels are both in normal range, yet surprisingly enough, many people with chronic pancreatitis test within the normal range, even in the midst of a bad pain attack.  I've got chronic pancreatitis and most times now I test within the normal range.  My GI doesn't even bother to test my a&l levels now, unless I am having an acute attack.

I'm not saying he has chronic pancreatitis, but that's what pancreatic insufficiency is.  There isn't really any special treatment for the condition, unless there is duct obstruction where it is necessary to go into the ducts and place a stent or do other surgical invervention.  Otherwise, the treatment consists of a low fat diet, enzyme supplements with all meals and snacks, and for most, who have frequent pain episodes, narcotic pain medication to help with the chronic pain.  

I'm sure your doctor advised him about the need for the low fat diet, especially with the higher triglycerides and high cholesterol.  And the enzyme supplements should help a lot, too.

Post again if you have any questions.
Nanny

[ttcoffin]

Thanks nanny. Yes, his doc mentioned the low fat diet and he actually sees a nutrioniest in September. I have very high cholestrol too, so I have a list the dietician gave me. I thought with chronic pancreatitis, they out you in the hospital, with IV and no eating for 5 days, to let the pancreas rest? Or did I get that part wrong? He is now taking the enzymes but haven't noticed a difference yet, don't know how long it will take for him to feel any better though. Iam sure now,that his pain has to be from the pancreas. He also found out he has crohns disease but this pain for the last 3 1/2 years, has been right where the pancreas is, in the upper middle stomach. It hurts just about all the time and eating and activity makes it worse. Whenever the docs push on it, he about jumps off the table, so it has to be pancreas related. Thanks for the info.